Boarding Registration Form | Bedford Veterinary Medical Center

This form does NOT act as a boarding reservation, this form allows our team to have the required information before your pets stay! *FOR MULTIPLE PETS – WE REQUIRE AN AGREEMENT FORM PER PET*

Client Information

Are you a current client of Bedford Veterinary Medical Center?(Required)

Owner Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Phone Number - list any additional number we can reach you at:(Required)

What is the best way to reach you while your pet is staying with us?(Required)

Phone

Text (if you provided a cell phone number only)

I will not be reachable, please use my emergency contact

Emergency Contact

Must be able to make medical decisions if you are not reachable.

Owner Name(Required)

First Last

Emergency Contact Phone(Required)

Relationship to Owner(Required)

Pet Information

ONLY ONE PET PER AGREEMENT FORM

Pet's Name(Required)

Is your pet current on vaccinations? Canine: Rabies, Distemper, Kennel Cough, HW Test Feline: Rabies, Distemper(Required)

Current Heartworm Prevention Product (required for boarding):(Required)

Please List Name and Last Date Given

Current Flea & Tick Prevention Product (required for boarding):(Required)

Please List Name and Last Date Given

Has your pet had a negative fecal exam in the past 6 months?*(Required)

Has your pet been to another boarding or daycare facility within the past two weeks?(Required)

If Yes, which facility?(Required)

Feeding Information

Please fill out feeding information below.

Please provide all dry food in indiviudal ziploc bags labeled with your pets name, the date food is provided for, and AM, MIDDAY or PM as required for the entirety that your is staying with us. Please label all canned food with your pets name, frequency and amount to feed on the front of the can. If you forget your pets food, we can provide you with a small bag of prescription bland house diet for an additional charge of the cost of the diet (usually $35-50 per 6-8pound bag). Note: We are unable to take in large bags of pet food - thank you for your cooperation!

Will you be providing your pet's food for their stay?(Required)

Name of Food:(Required)

How many times/day?(Required)

How much at each feeding?(Required)

Please list any additional information we should know about feeding your pet:(Required)
If none, please type N/A

Medication & Instructions(Required)
If none, please type N/A

I understand all medications must be brought in their original labeled bottles and/or packaging.(Required)
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Drop Off & Pick Up

Drop Off Time(Required)

2:30pm (weekends only)

3pm

3:30pm

4pm

4:30pm

5pm (weekday only)
MUST be between 3pm-5pm

Pick Up Time(Required)

8am (weekday only)

8:30am

9am

9:30am

10am

10:30am (weekends only)
MUST be between 8am-10:30am

Would you like your dog to do play and stay if there is availability?(Required)

If Yes, how many times:
If none, please type 'N/A'

Has your pet passed the LRVC/BVMC Daycare evaluation prior to boarding?(Required)

If your pet requires basic medical attention while in our care (example: anxiety, ear infection, hot spot, skin abrasions, upset stomach causing vomiting and/or diarrhea, etc.)- do you authorize treatment?(Required)
NOTE: If we do not hear back from you within 4 hours we will proceed as recommended by the Veterinarian on duty. We will always contact you as soon as possible for any urgent or emergency medical situations.

I understand if my pet is not picked up by 10am or is dropped off before 3pm, an additional day of boarding may be charged.(Required)
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I understand if my pet displays unpredictable and/or aggressive behavior towards any Animal Care Coordinators, I am required to make arrangements for my pet to be picked up immediately.(Required)
Initial Here

By signing your name, you agree to the terms below:

⦁ Reasonable precaution will be used against injury, escape, or death of said animal.

⦁ I understand that any additional items such as bowls, toys or bedding should be left at home unless approved ahead of time.

⦁ I understand that if my pet is due for any required vaccines or prevention while during their stay, or found to be overdue for required vaccines, I will be responsible for the cost.

⦁ I understand that any medical problem that develops with my pet and I am not reachable within 4 hours, my pet will be treated as deemed best by the veterinarians on duty and I assume full responsibility for the treatment expense involved.

⦁ The clinic and staff will not be held liable for problems that develop provided reasonable care and precautions are followed.

⦁ I have confirmed that all my contact information listed above is accurate.

⦁ I understand that my pet is to be dropped off and picked up during the listed hours only or an additional fee may apply.

⦁ I understand that no one is here overnight to supervise my pets.

I am at least 18 years of age.

Authorization Signature(Required)
First Name Last Name

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